Medicare beneficiaries living in New York and enrolled in Original Medicare, Part A and Part B, have various private health insurance options through Medicare Advantage (Medicare Part C), depending on the zip code in which they live. Medicare Advantage is required by law to offer at least the same benefits as Original Medicare. Like residents of other states, New York residents enrolled in Medicare Advantage are covered through their individual health plan and not through Original Medicare.
In New York, as in other states, you can sign up for Original Medicare starting three months before you turn 65 and ending four months after that date. This is the seven-month Medicare Initial Enrollment Period (IEP). Be aware that if you don't sign up for Original Medicare during your IEP, you can still join during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late-enrollment penalty in the form of higher premiums. Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
New York Medicare beneficiaries can sign up for Medicare Advantage plans as an alternative to their Original Medicare coverage. Offered by private insurance companies in New York, Medicare Advantage plans cover the same hospitalization and medical benefits offered by Original Medicare. New York Medicare Advantage plans may offer additional benefits such as vision, hearing, and dental coverage.
If you're already enrolled in a Medicare Advantage plan and wish to change plans, the best time to do so is during the Annual Election Period (AEP), also called Open Enrollment Period, which runs from October 15 to December 7 each year. In New York, as in other U.S. states, if you change Medicare plans during the AEP, your new coverage generally begins on October 15 of the following year.
If you have special circumstances during the year, you may be able to change Medicare plans during Special Enrollment Periods (SEPs). These events include moving to a new address, losing your current coverage, qualifying for other coverage, or changes in your current plan that affect your health benefits.
If you're enrolled in a Medicare Advantage plan and want to switch back to Original Medicare, Part A and Part B, you can do so during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year.
Medicare Advantage plan options in New York include, among others, Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPO) plans, Special Needs Plans (SNPs), Private Fee-for-Service (PFFS) plans, and Medical Savings Account (MSA) plans.
If you select an HMO plan, you are required to visit doctors, health-care providers, and hospitals on the health plan's list. You may also need a referral from your primary doctor to receive coverage for certain health services. If you want more flexibility, you can opt for an HMO Point-of-Service (HMO-POS) plan. HMO-POS plans allow you to go out of network for certain health services, but at a higher cost.
PPO plans are also available to Medicare beneficiaries in New York. These types of plans let you choose doctors, health-care providers, and hospitals outside of their own network, but you may end up paying more by exercising this option.
If you have special health needs, you can select Medicare SNPs, which generally limit enrollment to people with certain health conditions or those living in an institution (such as nursing homes) or people who also qualify for Medicaid. Medicare SNPs offer customized coverage to meet these specific conditions.
You may also opt for a Medicare PFFS, in which the plan itself decides how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense.
MSA plans are another option for Medicare Advantage beneficiaries in New York. MSA plans generally combine a high deductible with a savings account that beneficiaries can use to pay for their health care expenses.
Many Medicare Advantage plans include prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans (MA-PDs), and they combine health and prescription drug coverage (Medicare Part D) into one private insurance plan. Be aware that even if you choose to enroll in a Medicare Advantage or MA-PD plan, you are still enrolled in Original Medicare and must continue paying your Medicare Part B premiums in order not to lose your health coverage.
Private health insurance companies across the state of New York offer a variety of Medicare Advantage plans for Medicare beneficiaries. Each Medicare Advantage plan may charge different costs and may have different rules regarding services, and these rules may change on a yearly basis, so it's important for beneficiaries to compare available Medicare Advantage plans based on their own unique location and health needs.
The availability and cost of Medicare Advantage plans varies depending on your state and county of residence. Premiums for a Medicare Advantage plan with the same coverage and benefits can vary between different counties within the state of New York. Some Medicare Advantage plans in New York may offer premiums as low as $0; but do keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose.
Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare coverage. You also need to decide whether or not you want prescription drug coverage with your Medicare Advantage policy through a Medicare Advantage Prescription Drug plan. With all these options, you can see why it can be important to compare plans with the benefits and costs best suited to your specific health needs.
To start comparing Medicare Advantage plans in New York today, you can:
Medicare has neither reviewed nor endorsed this information.